Provider Demographics
NPI:1174189161
Name:SHOW-ME HEALTH INNOVATIONS LLC
Entity Type:Organization
Organization Name:SHOW-ME HEALTH INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECLUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-438-7778
Mailing Address - Street 1:10430 TINDALL RD
Mailing Address - Street 2:
Mailing Address - City:CADET
Mailing Address - State:MO
Mailing Address - Zip Code:63630-8283
Mailing Address - Country:US
Mailing Address - Phone:573-701-0651
Mailing Address - Fax:
Practice Address - Street 1:10430 TINDALL RD
Practice Address - Street 2:
Practice Address - City:CADET
Practice Address - State:MO
Practice Address - Zip Code:63630-8283
Practice Address - Country:US
Practice Address - Phone:573-701-0651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12345OtherIRS
12345OtherIRS